(Concord, NH) New Hampshire Department of Corrections Commissioner Phil Stanley has acknowledged that there had been significant spending increases in the department's medical and forensic unit over the last year. The department's medical costs have increased approximately $1 million. Commissioner Stanley is announcing a series of organizational and business practice changes to address this issue.

A recent technical assistance report recommended that the former medical and forensic division of the Department of Corrections be dismantled. This structure was replaced by site-based medical and forensic teams reporting directly to the warden of each of the four state prisons. "This will increase accountability and teamwork at each prison," Commissioner Stanley said.

All medical, dental, and mental health services are reporting directly to the warden of their facility. This will provide more direct accountability for cost containment and closer working relationships between health care and prison security. The Commissioner commented that quality care, which has been provided, would not be sacrificed.

Commissioner Stanley said, "I have been concerned with the need for better teamwork in this area. Lack of site-based accountability adds to inefficiency and higher costs."

Other changes have occurred since May 2000. Among those, the inmate intake screening process has been streamlined to eliminate some of the unnecessary initial screening tests. This is in line with national health care guidelines and will result in a more cost-effective intake process.

The department continues to negotiate with hospital and outpatient providers. Local providers have been very cooperative in renegotiating these lower costs, which will begin taking effect immediately. The number of hospital days used has increased. At Concord Hospital, there were 95 days used in 1997 compared to 115 in the fourth quarter of FY-01. This is consistent with an aging population. In 1991, the New Hampshire prison population of 40 years or older was 13.6%. In 2001, this percentage had nearly doubled to 23.9%.

"This population does not practice good health habits and when they come into the prison system, many of them have significant health issues," Stanley pointed out.

The department is running a trial onsite infectious disease clinic. Onsite medical specialty clinics have been shown to decrease costs when compared to taking inmates to outside consults.

While these changes have had a positive impact, increases in patient consults and higher medication costs have driven overall costs higher. The utilization of community consultations doubled from 1997 to 2001. On-site nursing consults rose 30.6% from FY-00 to FY-01.

Commissioner Stanley said, "We have to accomplish more on-site medical care by our own providers in an effort to reduce costs, but we won't sacrifice the quality of care provided to inmates."

"A process of consult review is being implemented but needs to be improved," he added.

Commissioner Stanley concluded, "I am distressed at the rising medical costs within the department and I am aware that past practices have been inefficient. I am giving this matter my complete attention and it is my goal to bring these costs under control."